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Hi there. Since you are coming for dinner and I happen to work for a company that sells survey software, I put together this survey to help make your time with us more enjoyable.
 
 
 
How many of you are coming and what are the kids ages(if any)?
   
 
 
Step 1 of 1
Please answer yes no
YesNo
Allergic to Cats?
Afraid of Dogs?
Play an instrument?
 
 
 
What appetizers sound good to you? (Select all that apply)
 
Butternut Squash Soup
 
Salad
 
Bruschetta
 
Hummus, veggies, crackers
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What kinds of vegetables do you like? (Select all that apply)
 
Broccoli
 
Carrots
 
Zucchini
 
Cauliflower
 
Artichoke
 
Mushrooms
 
Asparagus
 
Avocado
 
Tomato
 
Bell Peppers
 
Corn
 
Lettuce
 
Kale
 
Chard
 
Leeks
 
Garlic
 
Ginger
 
Sweet Potatoes
 
Cucumber
 
Celery
 
Butternut Squash
 
Green Juice
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What kind of proteins do you eat? (Select all that apply)
 
Salmon
 
Shrimp
 
Halibut
 
Chicken
 
Beef
 
Hot Dogs
 
Tofu
 
Tempeh
 
Rice and Beans
 
Spirulina
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What are your drink choices? (Select all that apply)
 
Hot Tea
 
Water
 
Cows Milk
 
Rice Milk
 
Soy Milk
 
Soda
 
Orange Juice
 
Apple Juice
 
Wine
 
Sake
 
Beer
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What ethnic cuisines do you like? (Select all that apply)
 
Thai
 
Japanese
 
Vietnamese
 
Chinese
 
Mexican
 
Indian
 
Cajun
 
Bar B Que
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What side dishes sound good to you? (Select all that apply)
 
French Fries
 
Roasted Potatoes
 
Mashed Potatoes
 
Baked Potatoes
 
White Rice
 
Brown Rice
 
Quinoa
 
Polenta
 
Pasta
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What do you like for Dessert? (Select all that apply)
 
Cookies
 
Real Ice Cream
 
Soy Ice Cream
 
Coconut Milk Ice Cream
 
Raw Gourmet Choc. Mousse Pie
 
Popsicles
 
Fruit
 
Brownies
 
Chocolate
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
What should not be in your food? (Select all that apply)
 
Seaweed
 
Shellfish
 
Peanuts
 
Gluten
 
Cows Milk
 
Soy
 
Eggs
 
Wheat
 
Corn
 
Yeast
 
Nightshades
 
Carbs
 
Sugar
 
Legos
 
All of the Above
 
None of the Above
 
Other
 

 
 
 
Is there anything else we need to know?:
   
 
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